Findings reveal abrupt narrowing of the celiac axis with hooked appearance
Final Diagnosis: Median Arcuate Ligament Syndrome
The median arcuate ligament is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. Indentation at superior aspect of the celiac artery causes compression, In certain individuals, compression of the celiac trunk resulting in mesenteric ischemia can occur. it is relieved by standing as the celiac artery descends inferiorly on standing/ inspiration.
CT reveals
acute angulation and indendation on the superior aspect of proximal celiac axis
focal narrowing has a characteristic hooked appearance
the MAL may be visible; a thickness of more than 4 mm is considered abnormal
Post stenotic dilatation
collateral vessel formation from the SMA branches
CT should be performed at end inspiratory phase, and also end inspiratory and end expiratory phase stenosis should be checked.Compression is considered severe if it persists on end-inspiration and if poststenotic dilatation and retrograde filling of the celiac axis from the SMA and pancreaticoduodenal arcade are present
